After recovery from myocardial infarction, patients should receive aspirin and statin therapy and be evaluated regarding their need for coronary revascularisation, additional pharmacological treatment and possible device therapy.
- A large evidence base and detailed guidelines are available to help guide management after an acute coronary syndrome (ACS) but tailoring this to individual patients can be challenging.
- Coronary revascularisation should be considered for all post-ACS patients with ongoing symptoms and critical coronary stenosis, left main disease or triple vessel coronary artery disease.
- All post-ACS patients should be given aspirin and statins. Use of a second antiplatelet medication, a beta blocker andan ACE inhibitor is determined by symptoms and the presence of left ventricular dysfunction.
- Prasugrel and ticagrelor are preferred over clopidogrel for use in dual antiplatelet therapy in most patients post ACS but have a higher bleeding risk.
- Use of an implantable cardioverter defibrillator is indicated in patients who had an MI more than 40 days previously and whose ejection fraction is persistently below 35%.